Signs and Changes in Pregnancy

Labor Signs

• Braxton Hicks contractions are periodic uterine tightenings felt as waves of hardness or tightening
• Sonographic evidence of gestational sac is an early sign of pregnancy
• Uterine souffle, a muffled swishing sound over the abdomen in union with the mother’s heartbeat, is a sign of pregnancy
• Pregnancy tests are used to confirm pregnancy

Cervical Changes

• The cervix of the uterus becomes more vascular and edematous, getting softer than normal, similar to the consistency of an earlobe (Goodell’s sign)
• The operculum, or mucus plug, fills the cervical canal to protect the fetus
• Goodell’s sign is the softening of the cervix during pregnancy

Vaginal Changes

• An increase in the activity of the epithelial cells leads to an increase in vaginal discharge

Molding

• Molding is the change in the shape of the fetal skull due to pressure from uterine contractions against the cervix
• The fetal skull bones overlap to form a narrow and long shape, facilitating passage through the pelvis

Components of Labor

• Passage: The pathway a fetus travels through the uterus, cervix, vagina, and external perineum
• Passenger: The fetus
• Powers: Uterine contractions and maternal pushing efforts
• Psyche: The woman’s psychological state

Mechanisms of Labor

• Cardinal movements: Position changes of the fetus as it passes through the birth canal
• Descent: Movement of the presenting part into the pelvic inlet
• Flexion: Fetal head flexes chin to chest, presenting smallest diameter
• Internal rotation: Head rotates to fit the pelvic outlet
• Extension: Head emerges from the vagina, extending back
• External rotation: The head rotates to align with the shoulders as they pass through the pelvis
• Expulsion: The body delivers, following the head

Stages of Labor

• First Stage: Begins with regular contractions and ends with complete cervical dilation (10 cm)
• Latent Phase: Mild and short contractions, lasting 20 to 40 seconds, cervix dilates from 0 to 4 cm
• Active Phase: Dilatation increases rapidly (4 to 7 cm per hour), contractions are stronger and longer
• Second Stage: Begins with full cervical dilation and ends with delivery of the baby
• Third Stage: Begins with delivery of the baby and ends with delivery of the placenta
• Fourth Stage: The hour following delivery, when the uterus contracts to control bleeding and stabilize

Cardiovascular System During Pregnancy

• An increase in total circulatory blood volume (30% or more)
• NSD (Normal Spontaneous Delivery) blood loss: 300-400 mL
• CS (Cesarean Section) blood loss: 800-1000 mL
• Blood volume changes ensure adequate blood supply to the mother and fetus

Placenta Delivery

• The placenta detaches from the uterine wall, resulting in bleeding
• Bleeding helps to separate the placenta further
• The placenta can be delivered spontaneously or manually

Ripening of the Cervix

• Ripening is an internal sign seen only on pelvic examination
• The cervix feels soft and similar to the consistency of an earlobe (Goodell’s sign)

Crowning

• As the fetal head pushes against the perineum, the vaginal introitus opens and the fetal scalp appears
• The opening changes from slitlike to oval and then circular
• The circle enlarges from the size of a dime to a quarter and then a half-dollar